Ask the Experts: HPV (Human Papillomavirus)

Results (50)

HPV is the most common sexually transmitted infection in the United States. HPV is so common that nearly all sexually active men and women contract the virus at some point in their lives. In the United States, more than 42 million people are infected with the types of HPV known to cause disease, and an estimated 13 million new HPV infections occur every year among people age 15 through 59 years. Approximately half of new infections occur among people age 15 through 24 years. The first HPV infection typically occurs within a few months to years of becoming sexually active.

Last reviewed: March 2, 2024

Most HPV infections are asymptomatic and go away completely on their own within 2 years after infection (usually in the first 6 months) without causing clinical disease. Some infections are persistent and can lead to genital warts, precancerous lesions, or cancer. Infections caused by certain HPV types cause almost all cases of anogenital warts in women and men and recurrent respiratory papillomatosis.

It can take years, even decades, for HPV infections to lead to cancer. According to CDC surveillance data from 2016 through 2020, every year in the United States, about 46,711 new cases of cancer (25,689 among women and 21,022 among men) are found in parts of the body where human papillomavirus (HPV) is often found (referred to as HPV-associated cancers). About 79% of these cancers are probably caused by HPV (referred to as HPV-attributable cancers).

Each year, between 2016 and 2020, nearly 12,000 cases of cervical cancer, the most widely known HPV-associated cancer, occurred in the United States. HPV is also associated with vulvar, and vaginal cancer in females, penile cancer in males, and anal and oropharyngeal cancer in both females and males. Between 2016 and 2020, oropharyngeal cancers were the most common HPV-associated cancers, with an average of 20,805 reported cases each year (17,248 among men and 3,557 among women).

See www.cdc.gov/cancer/hpv/cases.html for more information on trends in HPV-associated cancer.

Last reviewed: March 2, 2024

CDC estimated that 36,500 people developed cancers attributable to HPV infections each year between 2015 to 2019. Of these annual cases, about 94% could have been prevented by the 9-valent HPV vaccine, including about 30,100 cases caused by HPV types 16 and 18 and 4,300 cases caused by HPV types 31, 33, 45, 52, and 58.

HPV types 6 or 11 cause 90% of anogenital warts (condylomata) and most cases of recurrent respiratory papillomatosis.

For additional details, see www.cdc.gov/cancer/uscs/about/data-briefs/no31-hpv-assoc-cancers-UnitedStates-2015-2019.htm.

Last reviewed: March 2, 2024

There is no treatment for infection with the HPV virus itself. Only HPV-associated lesions including genital warts, recurrent respiratory papillomatosis, precancers, and cancers are treated. Recommended treatments vary depending on the diagnosis, size, and location of the lesion. Local treatment of lesions might not eradicate all HPV-containing cells fully. It is unclear whether treating the lesion reduces the risk that the infected person could transmit the HPV infection to others.

Last reviewed: March 2, 2024

Occupational infection with HPV is possible. Some HPV-associated conditions (including anogenital and oral warts, anogenital intraepithelial neoplasia, and recurrent respiratory papillomatosis) are treated with laser or electrosurgical procedures that could produce airborne particles. These procedures should be performed in an appropriately ventilated room using standard precautions and local exhaust ventilation. Workers in HPV research laboratories who handle wild-type viruses or “quasi virions” might be at risk of acquiring HPV from occupational exposures. In the laboratory setting, proper infection control should be instituted, including, at minimum, biosafety level 2. Whether HPV vaccination would be of benefit in these settings is unclear because no data exist on transmission risk or vaccine efficacy in this situation.

Last reviewed: March 2, 2024

Nonsexual HPV transmission is theoretically possible but has not been definitively demonstrated. This is mainly because HPV can’t be cultured, and DNA detection from the environment is difficult and likely prone to false negative results.

Last reviewed: March 2, 2024
  • If a person is infected with an HPV strain that does not clear (that is, the person becomes persistently infected) the person cannot be reinfected because they are continuously infected.
  • If a person is infected with an HPV strain that clears, some but not all people will have a lower chance of reinfection with the same strain. Data suggest that females are more likely than males to develop immunity after clearance of natural infection.
  • Prior infection with an HPV strain does not lessen the chance of infection with a different HPV strain.
Last reviewed: March 2, 2024

Gardasil 9 (9vHPV, Merck) is the only HPV vaccine being distributed in the United States. Bivalent Cervarix (2vHPV, GSK) and quadrivalent Gardasil (4vHPV, Merck) are no longer available in the United States.

9vHPV is an inactivated 9-valent vaccine licensed by the FDA in 2014. It contains 7 oncogenic (cancer-causing) HPV types (16, 18, 31, 33, 45, 52, and 58) and two HPV types that cause most genital warts (6 and 11). The 9vHPV vaccine is licensed for people age 9 through 45 years.

Last reviewed: March 2, 2024

The ACIP recommends that routine HPV vaccination be initiated for all children at age 11 or 12 years. ACIP notes that vaccination may be started at age 9 years, if preferred, and should start at age 9 for any child that the provider at risk of exposure to HPV due to suspected abuse. There is no downside to beginning the series at age 9, and this option is often easier for families and clinics because it gives more time to complete the 2-dose series before the 13th birthday. Vaccination is also recommended for all people age 13 through 26 years who have not been vaccinated previously or who have not completed the vaccination series.

Last reviewed: March 2, 2024

No. In June 2019, the Advisory Committee on Immunization Practices (ACIP) voted to recommend routine catch-up HPV vaccination of all previously unvaccinated or incompletely vaccinated males age 22 through 26, matching the recommendation for females. HPV vaccination recommendations now differ by age group only, not by biological sex. There is a routine recommendation for vaccination of all people 9 through 26 years of age and a shared clinical decision-making recommendation based on risk and preference for people 27 through 45 years of age.

Current ACIP recommendations for HPV vaccine are listed at www.cdc.gov/acip-recs/hcp/vaccine-specific/hpv.html.

Last reviewed: March 2, 2024

Catch-up HPV vaccination is not recommended for adults older than 26 years of age. Instead, shared clinical decision-making regarding HPV vaccination is recommended for some adults aged 27 through 45 years who are not adequately vaccinated and want to be protected from ongoing risk of acquiring new HPV infection.

Ideally, HPV vaccine should be administered before potential exposure to HPV through sexual contact.

Last reviewed: March 2, 2024

Although new HPV infections are most commonly acquired in adolescence and young adulthood, having a new sex partner at any age is a risk factor for acquiring a new HPV infection. In addition, some people have specific behavioral or medical risk factors for HPV infection or disease, including men who have sex with men, transgender people, and people with immunocompromising conditions. HPV vaccine works to prevent infection among people who have not been exposed to vaccine-type HPV before vaccination. A discussion with your patient is the best way to decide together how much the patient may benefit from HPV vaccination to prevent new HPV infections.

Last reviewed: March 2, 2024

Because HPV acquisition generally occurs soon after first sexual activity, vaccine effectiveness will be lower in older age groups as a result of prior infections. In general, exposure to HPV also decreases among individuals in older age groups. Evidence suggests that although HPV vaccination is safe for adults 27 through 45 years, population benefit would be minimal; nevertheless, some adults who are unvaccinated or incompletely vaccinated might be at risk for new HPV infection and might benefit from vaccination in this age range.

Last reviewed: March 2, 2024

No. There is no screening laboratory test that can determine whether a person is already immune or still susceptible to any given HPV type. Most sexually active adults have been exposed to one or more HPV types, although not necessarily all of the HPV types targeted by vaccination. HPV vaccine works to prevent infection with vaccine types to which a person is still susceptible.

Last reviewed: March 2, 2024

Complete the series based on shared clinical decision-making involving the patient’s risk and desire for protection.

Last reviewed: March 2, 2024

ACIP recommends a routine 2-dose HPV vaccine schedule for adolescents who start the vaccination series before the 15th birthday. The two doses should be separated by 6 to 12 months. The minimum interval between doses is 5 calendar months.

A 3-dose schedule is recommended for all people who start the series on or after the 15th birthday and for people with certain immunocompromising conditions (such as cancer, HIV infection, or taking immunosuppressive drugs). The second dose should be given 1 to 2 months after the first dose, and the third dose should be given 6 months after the first dose. The minimum interval between the first and second doses of vaccine is 4 weeks. The minimum interval between the second and third doses of vaccine is 12 weeks. The minimum interval between the first and third dose is 5 calendar months.

If the vaccination series is interrupted, the series does not need to be restarted.

Last reviewed: March 2, 2024

Coverage levels for HPV vaccine are improving but are still inadequate. Results from CDC’s 2022 National Immunization Survey-Teen (NIS-Teen) indicate that for the first time since 2013, HPV vaccination initiation did not increase among adolescents age 13 through 17 years. HPV vaccination initiation actually fell among adolescents insured by Medicaid and remained lowest among the uninsured. The Vaccines for Children (VFC) program ensures access to HPV and other routine vaccines for adolescents who are uninsured or Medicaid-eligible at no cost. It is important that families are aware of this entitlement and the importance of HPV vaccination.

In 2022, 76% of adolescents had received at least 1 dose of HPV vaccine and 62.6% were up to date with HPV vaccination. A summary of the 2022 NIS-Teen survey and trends are available at www.cdc.gov/mmwr/volumes/72/wr/mm7234a3.htm.

Providers can improve uptake of this life-saving vaccine in several ways. First, studies show that missed opportunities are occurring. Some clinics address this by routinely starting the 2-dose vaccination series as early as possible, at age 9, giving them more chances to complete the series on time before age 13. A different strategy to improve uptake is by ‘bundling’ the recommendations for all adolescent vaccines at the first preteen visit. CDC recommends the following discussion starter: “Now that your child is 11, they need three vaccines to help protect against meningitis, HPV cancers, and whooping cough. We’ll give these shots during today’s visit. Do you have any questions about these vaccines?”

One of the main reasons parents give researchers for not vaccinating their adolescents is that the HPV vaccine was not recommended to them by their child’s healthcare provider. CDC urges healthcare providers to strongly and consistently recommend HPV vaccine, especially when patients are age 11 or 12 years. CDC’s “Talking to Parents about HPV Vaccine,” available at www.cdc.gov/hpv/media/pdfs/2024/07/talking_to_parents_HPV.pdf can help providers with these conversations.

For more detailed information about HPV vaccination strategies for providers, visit www.cdc.gov/hpv/hcp/boosting-vacc-rates.html and www.cdc.gov/vaccines/partners/routine-immunizations-lets-rise.html.

Last reviewed: July 26, 2024

Explain to the parent that vaccination starting at 11 or 12 years will provide the best protection possible long before the start of any kind of sexual activity. It is standard practice to vaccinate people before they are exposed to an infection, as is the case with measles and the other recommended childhood vaccines. Similarly, we want to vaccinate children before they get exposed to HPV. Studies of HPV vaccine indicate that younger adolescents respond better to the vaccine than older adolescents and young adults. Healthy children vaccinated at this age will need only 2 doses of vaccine rather than 3 doses if vaccinated at an older age. Finally, numerous research studies have shown that getting the HPV vaccine does not make kids more likely to be sexually active or start having sex at a younger age.

Last reviewed: March 2, 2024


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Last reviewed: April 6, 2023

There is no ACIP recommendation for additional doses of 9vHPV for people who started the series with 2vHPV or 4vHPV and completed the series with 9vHPV.

Last reviewed: March 2, 2024

ACIP and CDC do not recommend revaccination with 9vHPV of people who have completed a recommended series of another HPV vaccine given at appropriate dosing intervals.

Last reviewed: March 2, 2024

Yes.

Last reviewed: March 2, 2024

Yes. Vaccinated women still need to see their healthcare provider for periodic cervical cancer screening. The vaccine does not provide protection against all types of HPV that cause cervical cancer, so even vaccinated women will still be at a small risk for some cancers from HPV.

Last reviewed: March 2, 2024

Yes. HPV vaccine is recommended for all people through age 26 years, regardless of sexual orientation or gender identity.

Last reviewed: March 2, 2024

ACIP recommends vaccination with 3 doses of HPV vaccine for people age 9 through 26 years with primary or secondary immunocompromising conditions that might reduce cell-mediated or humoral immunity. Examples include B lymphocyte antibody deficiency, T lymphocyte complete or partial defects, HIV infection, malignant neoplasm, transplantation, autoimmune disease, or immunosuppressive therapy. In these circumstances, the 3-dose series is recommended even for those who initiate vaccination at age 9 through 14 years when the routine recommendation is for a 2-dose series.

Last reviewed: March 2, 2024

No. The recommendation for a 3-dose HPV schedule does not apply to people with asplenia and neither does it apply to children 9 through 14 years with asthma, chronic granulomatous disease, chronic liver disease, chronic renal disease, central nervous system, anatomic barrier defects (such as a cochlear implant), complement deficiency, diabetes, heart disease or sickle cell disease unless the person is receiving immunosuppressive therapy for the condition.

Last reviewed: March 2, 2024

Yes. HPV vaccine should be administered to people who are already sexually active if age appropriate. Routine catch-up vaccination of any person not vaccinated on schedule as a preteen is recommended through age 26 years, and vaccination may be considered with shared clinical decision-making between ages 27 and 45. Ideally, patients should be vaccinated before the onset of sexual activity; however, people who have already been infected with one or more HPV types will still be protected from other HPV types in the vaccine that have not been acquired.

Last reviewed: March 2, 2024

In clinical trials, HPV vaccines were shown to be highly effective (more than 95%) for prevention of HPV vaccine-type infection and disease among people without prior infection with the HPV types included in the vaccine. The most likely explanation for this situation is that the patient was exposed to at least HPV types 16 and 18 prior to vaccination. The HPV vaccine is not effective in preventing infection from HPV types a person has been exposed to prior to vaccination. The vaccine also cannot prevent progression of HPV infection or HPV-related disease. The 9vHPV vaccine protects against 9 different types of HPV.

Last reviewed: March 2, 2024

A history of genital warts or clinically evident genital warts indicates previous infection with HPV, most often type 6 or 11, which cause 90% of genital warts. However, people with this history might not have been infected with both HPV 6 and 11 or with the other HPV types included in HPV vaccine. Vaccination will provide protection against infection with HPV serotypes the patient has not already acquired. Providers should advise their patients/clients that the vaccine will not have a therapeutic effect on existing HPV infection or genital warts. It is important, however, that patients receive a full age-appropriate series of HPV vaccine to get full protection from genital warts, in addition to the cancer-causing HPV types in the vaccine.

Last reviewed: March 2, 2024

ACIP recommends a routine 2-dose HPV vaccine schedule for adolescents who start the vaccination series before the 15th birthday. The two doses should be separated by 6 to 12 months. The minimum interval between doses is 5 calendar months.

A 3-dose schedule is recommended for people who start the series on or after the 15th birthday and for people with certain immunocompromising conditions (such as cancer, HIV infection, or taking immunosuppressive drugs), regardless of their age at the time of the first dose. The second dose should be given 1 to 2 months after the first dose and the third dose 6 months after the first dose. The minimum interval between the first and second doses of vaccine is 4 weeks. The minimum interval between the second and third doses of vaccine is 12 weeks. The minimum interval between the first and third doses is 5 calendar months. If the vaccination series is interrupted, the series does not need to be restarted.

Last reviewed: March 2, 2024

Yes. ACIP recommends the 2-dose schedule for people starting the HPV vaccination series before the 15th birthday, as long as they are immunocompetent.

Last reviewed: March 2, 2024

No, do not restart the series. You should continue where the patient left off and complete the series.

Last reviewed: March 2, 2024

Yes. A dose administered up to 4 days before the minimum interval for that dose may be counted as valid and does not need to be repeated.

Last reviewed: March 2, 2024

Yes. If an HPV vaccine dose is administered at less than the recommended minimum interval, then the dose should be repeated. The repeat third dose should be repeated 5 months after the first dose or 12 weeks after the invalid third dose, whichever is later.

Last reviewed: March 2, 2024

Yes. Adolescents and adults who started the HPV vaccine series prior to the 15th birthday and who are not immunocompromised are considered to be adequately vaccinated with just one additional dose of HPV vaccine.

Last reviewed: March 2, 2024

People who have received 2 doses of HPV vaccine separated by less than 5 months should receive a third dose 6–12 months after dose #1 and at least 12 weeks after dose #2, regardless of their age at the time of the first dose. The recommended interval for the second dose in the 2-dose schedule (indicated when the first dose is given before age 15) is 6 months and the minimum interval is 5 months.

Last reviewed: March 2, 2024

Yes. Any person who ever received 2 doses of any combination of HPV vaccines can be considered fully vaccinated if dose #1 was given before the 15th birthday and the 2 doses were separated by at least 5 months.

Last reviewed: March 2, 2024

No vaccine series needs to be restarted because of an interval that is longer than recommended (with the exception of oral typhoid vaccine in certain circumstances). You should resume the HPV vaccine series where it was interrupted.

Last reviewed: March 2, 2024

HPV vaccine is not recommended for use during pregnancy. HPV vaccines have not been associated causally with adverse outcomes of pregnancy or adverse events in the developing fetus. However, if a person is found to be pregnant after initiating the vaccination series, the remainder of the series should be delayed until completion of pregnancy. Pregnancy testing is not needed before vaccination.

If a vaccine dose has been administered during pregnancy, no intervention is needed.

Last reviewed: March 2, 2024

You should withhold further HPV vaccine until she is no longer pregnant. After the pregnancy is completed, administer the remaining doses of the series using the usual 2- or 3-dose schedule (depending on the age at initiation of the series).

Last reviewed: March 2, 2024

Yes, administration of a different inactivated or live vaccine, either at the same visit or at any time before or after HPV vaccine, is acceptable because HPV is not a live vaccine.

Last reviewed: March 2, 2024

Yes. No data exist on the efficacy or safety of HPV vaccine given by the Subcut route. All data on efficacy and duration of protection are based on a vaccine series administered by the IM route. In the absence of data on Subcut administration, CDC and the manufacturer recommend that a dose of HPV vaccine given by any route other than IM should be repeated. There is no minimum interval between the invalid (Subcut) dose and the repeat IM dose.

Last reviewed: March 2, 2024

Contraindications are the following:

  • HPV vaccine is contraindicated for people with a history of immediate hypersensitivity to any vaccine component, including yeast.
  • The precaution to HPV vaccine is a moderate or severe acute illness with or without fever. Vaccination should be deferred until the condition improves.

HPV vaccines are not recommended for use during pregnancy. If a person is found to be pregnant after starting the vaccination series, the remainder of the 2- or 3-dose series (depending on the age of first HPV vaccination) should be delayed until completion of pregnancy. Pregnancy testing is not needed before vaccination. If a vaccine dose has been administered during pregnancy, no intervention is needed. You can find more information about HPV vaccine and pregnancy in the ACIP recommendations at: www.cdc.gov/mmwr/preview/mmwrhtml/rr6305a1.htm.

Last reviewed: March 2, 2024

Yes. A woman with evidence of present or past HPV infection identified through cervical screening may be vaccinated, and should be vaccinated if age 26 or younger. Infection with one type of HPV does not prevent infection with additional types. Vaccination can prevent infections with additional HPV types included in the vaccine. Recipients of HPV vaccinations should be counseled that the vaccine will not have a therapeutic effect on any existing HPV infections or cervical lesions. In other words, vaccination does not treat existing HPV infections or the lesions (warts, cancer, or pre-cancerous changes) caused by them.

Last reviewed: March 2, 2024

Yes.

Last reviewed: March 2, 2024

No. Even a woman found to be infected with a strain of HPV that is present in the vaccine could receive protection from the other strains in the vaccine.

Last reviewed: March 2, 2024

In clinical trials of 9vHPV (Gardasil 9, Merck) involving more than 15,000 vaccine recipients, most adverse events were mild or moderate injection site-related pain, swelling, and redness. Up to 40% reported one of these injection site reactions after vaccination, and they were more common among females compared to males. Injection site reactions also were more likely following the second or third dose compared to the first dose. Fewer than 10% of recipients reported fever.

Last reviewed: March 2, 2024

No. Since 2006, well over 100 million doses of HPV vaccine have been administered in the United States. Among all reports to the Vaccine Adverse Event Reporting System (VAERS) following HPV vaccines, the most frequently reported symptoms overall were dizziness; fainting; headache; nausea; fever; and pain, redness, and swelling in the arm where the shot was given. Although deaths have been reported among vaccine recipients none has been conclusively shown to have been caused by the vaccine. Occurrences of rare conditions, such as Guillain-Barré Syndrome (GBS) have also been reported among vaccine recipients but there is no evidence that HPV vaccination increased the rate of GBS above what is normally expected in the population.

CDC, working with the FDA and other immunization partners, continues to monitor the safety of HPV vaccines. You can find complete information on this and other vaccine safety issues www.cdc.gov/vaccine-safety/vaccines/hpv.html and at www.cdc.gov/vaccine-safety/vaccines/hpv.html.

Last reviewed: March 2, 2024

Nearly all vaccines have been reported to be associated with fainting (syncope). Post-vaccination syncope has been most frequently reported after three vaccines commonly given to adolescents (HPV, MenACWY, and Tdap). However, it is not known whether the vaccines are responsible for post-vaccination syncope or if the association with these vaccines simply reflects the fact that adolescents are generally more likely to experience syncope due to needle- and pain-related anxiety.

Syncope can cause serious injury. Falls that occur due to syncope after vaccination can be prevented by having the vaccinated person seated or lying down. The person should be observed for 15 minutes following vaccination. For additional information about vaccination-associated syncope, see Immunize.org’s clinical resource, Vaccination-Related Syncope: Information for Healthcare Personnel at www.immunize.org/wp-content/uploads/catg.d/p4260.pdf.

Last reviewed: March 2, 2024

HPV vaccine should be stored at refrigerator temperature between 2°C and 8°C (36°F and 46°F). The vaccine must not be frozen and must not be used if it has been frozen. Protect the vaccine from light. Administer as soon as possible after being removed from refrigeration. The manufacturer package insert contains additional information and can be found at https://www.immunize.org/official-guidance/fda/pkg-inserts/. For complete information on vaccine storage and handling best practices and recommendations, please refer to CDC’s Vaccine Storage and Handling Toolkit at www.cdc.gov/vaccines/hcp/admin/storage/toolkit/storage-handling-toolkit.pdf.

Last reviewed: March 2, 2024

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